Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
BMJ Case Rep. 2022 Apr 20;15(4):e248545. doi: 10.1136/bcr-2021-248545.
We present an 11-year-old girl who manifested with unprovoked right-sided focal motor seizures. CT revealed a large lobulated hypodense mass in the left temporoparietal lobe, with perilesional oedema and postcontrast peripheral enhancement. Diagnostic uncertainty resulted in further neuroimaging, which included MRI with modalities including diffusion-weighted imaging, perfusion imaging, as well as spectroscopy. We discuss the radiological features of the lesion, which steered us in the direction of an infective cause. Definitive diagnosis was achieved by brain needle biopsy, which demonstrated necrotising granulomatous inflammation indicative of tuberculous infection on histology. In addition, GeneXpert yielded a positive result. We believe this unique case highlights the diagnostic dilemma clinicians face in differentiating ring-enhancing lesions on neuroimaging in tuberculosis-endemic regions. It also highlights the potential benefit of a brain needle biopsy (histology and GeneXpert) in cases of uncertainty.
我们报告了一例 11 岁女孩，她表现为自发性右侧局灶性运动性癫痫发作。CT 显示左颞顶叶有一个大的分叶状低密肿块，伴有周边水肿和对比后外周增强。诊断不确定导致进一步进行神经影像学检查，包括 MRI 及其包括弥散加权成像、灌注成像和波谱学等方式。我们讨论了病变的放射学特征，这些特征引导我们考虑感染性病因。通过脑针活检明确诊断，组织学显示坏死性肉芽肿性炎症，提示结核感染。此外，GeneXpert 检测结果为阳性。我们认为这个独特的病例突出了在结核病流行地区，神经影像学上出现环形增强病变时临床医生所面临的诊断困境。它还突出了在不确定情况下进行脑针活检（组织学和 GeneXpert）的潜在益处。
